ObjectiveThe inflammatory arthritides (IA) make up a significant proportion of conditions followed‐up in rheumatology clinics. These patients require regular monitoring, but this is increasingly difficult with rising patient numbers and demand on clinics. Our objective is to evaluate the clinical impact of electronic Patient Reported Outcome Measures (ePROMs) as a digital remote monitoring intervention on disease activity, treatment decisions and healthcare resource use in patients with IA.MethodsFive databases (MEDLINE, Embase, PubMed, Cochrane Library and Web of Science) were searched, with randomised controlled trials (RCT) and (non‐randomised) controlled clinical trials included, and meta‐analysis and forest plots conducted for each outcome. Risk of bias was assessed using the Risk of Bias (RoB)‐2 tool and Risk Of Bias In Non‐randomised Studies ‐ of Interventions (ROBINS‐I).ResultsEight studies were included with a total of 4,473 patients, with 7 studies assessing patients with rheumatoid arthritis. Compared with control, the disease activity in the ePROM group was lower (standardised mean difference (SMD) ‐0.15; 95% CI ‐0.27 to ‐0.03) and rates of remission/low disease activity were higher (OR 1.65; 95% CI 1.02 to 2.68), but 5 of 8 studies provided additional combined interventions (eg. disease education). Fewer f2f visits were needed in the remote ePROM group (SMD ‐0.93; 95% CI ‐2.14 to 0.28).ConclusionMost studies were at high risk of bias with significant heterogeneity in design, but our results suggest there is an advantage in using ePROM monitoring in patients with IA, with potential for reduction in healthcare resource use without detrimental impact in disease outcomes.This article is protected by copyright. All rights reserved.

Background/Aims The inflammatory arthritides make up a majority of conditions requiring follow-up in rheumatology clinics; a treat-to-target management approach is advocated in patients with inflammatory arthritis (IA), requiring regular monitoring. With rising patient numbers and increasing demand on clinics, integration of digital healthcare has been advocated as a means to improving this, potentially allowing for fewer outpatient visits. The objective of this review is to evaluate the clinical effectiveness of electronic patient-reported outcome measures (ePROMs) as a digital remote monitoring intervention on disease activity and treatment decisions in patients with inflammatory arthritis. Methods Five databases including MEDLINE, Embase, PubMed, Cochrane Library and Web of Science were searched from inception to 29 August 2022. Randomised controlled trials (RCT) and (non-randomised) controlled clinical trials considering remote monitoring with ePROMS in IA samples that assessed disease activity scores, disease flare, treatment escalation and healthcare use were included, with meta-analysis and forest plots conducted for each outcome. Data regarding between-group differences in outcomes were extracted and a risk of bias assessment was completed by two assessors on all included studies using Cochrane Risk of Bias (RoB)-2 tool for RCTs and Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) for non-randomised cohorts. Results The literature search identified 4230 abstracts, of which 8 relevant studies were included in the analysis after de-duplication and screening. Seven studies assessed patients with rheumatoid arthritis and one involved patients with axial spondyloarthritis. Most included studies were at high risk of bias. Compared with control, the disease activity in the ePROM group was lower (standardised mean difference (SMD) -0.15; 95% CI -0.27 to -0.03). A second analysis using a stricter definition of ePROM use limiting to studies without other combined interventions (eg. disease education) showed the same direction of effect but was not significant (SMD -0.13; 95% CI -0.31 to 0.04). There were no significant differences between groups in terms of disease flare (OR 2.32; 95% CI 0.21 to 25.28), escalation of immunosuppression (OR 1.12; 95% CI 0.70 to 1.80) or face-to-face clinic visits (OR -0.93; 95% CI -2.14 to 0.28). Conclusion This review suggests there is an advantage in using ePROMs to remotely monitor patients with IA in terms of disease outcomes. Importantly there was no detrimental impact in terms of clinic attendance frequency with ePROMs. There are limitations including heterogeneity in study design and substantial risk of bias in the studies included. ePROMs are likely here to stay, but we need better quality data to fully understand their role in clinical practice. Disclosure N. Arumalla: None. M. Adas: None. C.K.D. Chan: None. M. Gibson: None. Y.L. Man: None. S. Norton: None. J. Galloway: Honoraria; from AbbVie, Celgene, Chugai, Galapagos, Gilead, Janssen, Lilly, Pfizer, Roche and UCB. T. Garrood: None.

Background/Aims Emerging adulthood is a unique developmental period between late adolescence and establishment of personal and social identity associated with adulthood. Emerging adult populations may have distinctive experiences of adult healthcare and their needs may differ from those of older healthcare users. Little is known about the patterns of presentation, experiences of care or disease outcomes of emerging adults in adult rheumatology settings. We used the National Early Inflammatory Arthritis Audit (NEIAA) to describe differences between emerging and older adult patients diagnosed with early inflammatory arthritis (EIA). Methods NEIAA is an observational cohort design study assessing care against National Institute for Health and Clinical Excellence quality metrics. Adults in England and Wales with a confirmed new diagnosis of inflammatory arthritis between May 2018 and April 2022 were grouped into two categories: emerging adults (16-24 years) and older patients (≥25 years). Patient characteristics, disease phenotype (including oligo- or polyarticular presentation) and initial treatment strategy were described. Results A total of 20,472 patients were included. 571 (2.8%) diagnosed with EIA were emerging adults (EA); this group had higher proportions of females (71.8%). Compared to older patients, EA patients were less likely to ever smoke (44.1% vs 69.5%) and had fewer comorbidities. EA patients were more likely to have oligoarticular symptoms (<5 tender and swollen joints; 53% vs 37%). Symptom duration prior to diagnosis was longer for EA patients (46% describing symptom duration >6 months vs 37%). Median Disease Activity Score/DAS28 at presentation was lower (4.2 vs 4.7). There were no differences in symptom burden as measured by the mean musculoskeletal health questionnaire (25 vs 24). EA patients completed fewer patient reported outcomes (33% vs 39%), but were more likely to complete all forms (20% vs 17%). Disease modifying anti-rheumatic drugs treatment strategies appeared similar, although more EA patients did not start medications by three months (26% vs 19%). Fewer EA patients received steroids (56% vs 71%).There were no significant differences between groups in patient numbers referred within three days of symptom onset from primary care or reviewed within three weeks with treatment initiation within six weeks in rheumatology care. More of the EA group were in employment at diagnosis. The EA population reported higher impairment at work (Work Productivity and Activity Index overall score 38% vs 30%, driven by difference in presenteeism). Conclusion Low proportion of EA patients in this EIA population raises concern that the study is not capturing a representative sample of this younger and developmentally distinct population. Available data suggest important differences in time to presentation, disease pattern and pathways of care between EA and older patients. EA population deserves further detailed investigation, exploring frequency and patterns of EIA and identifying particular issues faced when using adult rheumatology services. Disclosure M. Adas: None. N. Arumalla: None. D. Mclaughlin: None. J. Galloway: Honoraria; from AbbVie, Celgene, Chugai, Galapagos, Gilead, Janssen, Lilly, Pfizer, Roche and UCB. J. Ledingham: Other; is a BSR trustee. F. Mcerlane: None.

Background/Aims The Musculoskeletal Health Questionnaire (MSK-HQ) is a patient-reported outcome measure developed for use across the spectrum of musculoskeletal diseases. This study assesses the validity of the MSK-HQ. Specifically, it analyses convergent validity, construct validity, reliability and sensitivity to change in inflammatory arthritis in a national prospective cohort, with a minimum clinically important difference (MCID) defined. Methods The study sample included patients recruited to the National Early Inflammatory Arthritis Audit (NEIAA) between May 2018 and March 2020, with a diagnosis of inflammatory arthritis, returning a baseline PROM with at least half of the MSK-HQ items completed. Patients also completed PROMs at 3 and 12 months, contemporaneously to their clinic visits. Convergent validity was assessed in relation to the Health Assessment Questionnaire (HAQ)-II, Patient Health Questionnaire (PHQ)-4 and Disease Activity Score (DAS)-28. Construct validity was assessed using confirmatory factor analysis. Due to lack of an appropriate anchor, MCID was estimated based on two estimates for reliable change: standard error of the measurement (SEM) and one-third of a standard deviation (SD). Results A total of 13,129 patients were recruited to NEIAA, of whom 5,106 met the inclusion criteria. Of these 73% had rheumatoid arthritis, 13% psoriatic arthritis, 2% axial spondyloarthritis, and 12% undifferentiated arthritis. The MSK-HQ total score was approximately normally distributed, without floor or ceiling effects. The MSK-HQ correlated well with the HAQ-II (r = -0.79), PHQ-4 (r = -0.66) and moderately with the DAS-28 (r = -0.42). A unidimensional structure for the MSK-HQ was confirmed only when items 12 and 13, corresponding to disease understanding and self-efficacy, were excluded. The factor structure was found to be equivalent across disease subtypes with no major indications for differential item functioning. The MSK-HQ total score demonstrated good sensitivity to change with baseline to 12-month change having a large effect size (standardised response mean 1.01; 95%CI 0.95 to 1.07). This change compared well against the DAS-28 (-1.23; 95%CI -1.29 to -1.17) and was stronger than the HAQ-II (-0.62; 95%CI -0.68 to -0.56) and PHQ-4 (-0.57; 95%CI -0.63 to -0.51). MCID for the overall sample was 3.9 based on SEM and 3.6 assessed with one-third of an SD, both rounding to an integer of 4-points across the inflammatory arthritis subtypes. Conclusion This study provides evidence for the validity and sensitivity to change of the MSK-HQ in patients with inflammatory arthritis. In these patients, a change of more than 4 units is likely to be clinically meaningful. The MSK-HQ has high convergent and construct validity and is sensitive to change, providing a valuable tool for clinical care and research studies. Disclosure N. Arumalla: None. J. Galloway: Consultancies; AbbVie, Celgene, Chugai, Galapagos, Gilead, Janssen, Lilly, Pfizer, Roche and UCB. J. Ledingham: Other; BSR trustee. T. Garrood: None. S. Norton: None.